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The impact of 3D conformal radiotherapy versus intensity-modulated radiotherapy on post-operative wound complications in soft tissue sarcomas of the extremity and chest-wall

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Background

Pre-operative radiotherapy (RT) followed by limb-sparing resection is commonly used to treat soft tissue sarcomas (STS) of the extremity and chest-wall; however, this is associated with an increased risk of post-operative wound complications (WCs) compared to adjuvant RT. The use of intensity-modulated radiotherapy (IMRT) in STS has been investigated; however, the impact on WC is sparsely reported. In this study, we assess the rates of WC in patients who underwent pre-operative 3D conformal RT (3D CRT) versus IMRT followed by surgery for STS.

Methods

From 2000 to 2012, 196 patients with localized STS were treated with RT +/− chemotherapy followed by resection. Patient, treatment variables, and outcomes were reviewed. Predictors for WC were evaluated using Fisher’s exact test for univariate analysis (UVA) and logistic regression for multivariate analysis (MVA).

Results

Median follow-up was 3.5 years. Of patients, 33.7 % were treated with IMRT and 66.3 % were treated with 3D CRT. Of patients, 28.6 % developed post-operative WCs. Eighteen percent of patients developed WCs when treated with IMRT versus 33 % who received 3D CRT (p = 0.03). In lower extremity tumors only, 20 % of patients that received IMRT and 43 % of patients that received 3D CRT patients had WC (p = 0.01). On MVA, both upper extremity STS (p = 0.0005, OR 0.14) and IMRT (p = 0.02, OR 0.40) predicted for a decreased propensity for post-operative WC.

Conclusions

IMRT was associated with a significantly decreased risk of post-operative WCs compared to patients who received 3D CRT for their STS. Further studies and a larger sample size are needed to corroborate these findings.

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Abbreviations

RT:

Radiotherapy

STS:

Soft tissue sarcomas

WC:

Wound complications

IMRT:

Intensity-modulated radiotherapy

3D CRT:

3D conformal radiotherapy

UVA:

Univariate analysis

MVA:

Multivariate analysis

LC:

Local control

Gy:

Gray

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Authors and Affiliations

  1. Departments of Radiation Oncology, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI, 53226, USA

    Hina Saeed, Candice Johnstone & Manpreet Bedi

  2. Departments of Orthopaedic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI, 53226, USA

    David M. King, Donald A. Hackbarth & John C. Neilson

  3. Departments of Medical Oncology, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI, 53226, USA

    John Charlson

Authors
  1. Hina Saeed
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  2. Candice Johnstone
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  3. David M. King
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  4. John Charlson
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  5. Donald A. Hackbarth
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  6. John C. Neilson
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  7. Manpreet Bedi
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Corresponding author

Correspondence to Manpreet Bedi.

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This research was reviewed and approved by the Institutional Review Board and all investigators completed training in both human research and patient privacy.

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There was no funding support associated with this study.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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For this type of study, formal consent is not required.

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Saeed, H., Johnstone, C., King, D.M. et al. The impact of 3D conformal radiotherapy versus intensity-modulated radiotherapy on post-operative wound complications in soft tissue sarcomas of the extremity and chest-wall. J Radiat Oncol 5, 389–394 (2016). https://doi.org/10.1007/s13566-016-0277-0

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  • DOI: https://doi.org/10.1007/s13566-016-0277-0

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